Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Sjogren's syndrome

Nosebleed Section

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There are many aspects of last week’s writing retreat in Maine that were wonderful: intense focus on my novel, no-one to answer to but myself, beautiful beaches to walk nearby, quiet. I made real progress and hit all my revision goals. There is still work to do, but in four-and-half concentrated days, I accomplished what would have probably taken me two months. By the time I left my little rented cottage on Friday morning, my brain was fried, but I was elated.

That is not to say, however, that the trip was free of interruptions. There was the SNAFU with non-functional WIFI for two days, which turned out to be mostly Spectrum’s fault. (Fortunately I had downloaded my manuscript from the cloud prior to leaving.) There was also the delivery of a new stove and refrigerator, which had been delayed by the pandemic. There was the owner’s angst over grease stains on the new kitchen rug, due to the aforementioned delivery. My experience writing in a news room decades ago came in handy, and I was able to ignore the commotion in the kitchen and still write while all that mishegas was going on.

Then there was the nosebleed. From time to time, because my nose is quite dry due to Sjogren’s Syndrome, which can often accompany scleroderma, I experience nasty nosebleeds. I’m careful with saline sprays and rinses to help keep my nasal passages moisturized. But it can get the better of me. The weekend before I left, I had a gusher on Sunday that took at least a half-hour to bring under control. Then, the Saturday before I left, I had another spontaneous nosebleed from the back of my nose, which took at least 45 minutes to stop.

Worried about the trip, I called my clinic to see if I should go to urgent care for an exam. The nurse took copious notes and checked with the covering physician, who said there was no point in being seen, since the bleeding had stopped, but to be sure to keep my nostrils moisturized. He said to beware of saline, which can also be drying (this I’ve also learned from experience), but added a tip: use a small amount of Vaseline inside each nostril. This sounded rather odd to me. I thought it might affect my breathing or sense of smell. But I decided to try it out.

To my amazement, the thin coating actually felt good. As I packed the next morning, I made sure to have my new little jar of Vaseline, plenty of cotton swabs and tissues, plus cotton balls and decongestant spray if I had another bad bleed. I was relieved to drive all the way to Maine, unpack, shop for food, and make supper without incident.

Just as I was doing my dishes, however, I suddenly felt the bleeding start again in the back of my right nostril. Though not quite as bad as the previous day, which involved both sides, it once again took at least 45 minutes to control. I was not happy. After calling Al to discuss options, and calling my clinic after hours, I was able to speak once again to a nurse who said if it happened overnight, I’d need to go to the nearest ER (15 minutes away in Portland). If I had another bleed in the day, I should go to urgent care. And when I got home, I should call my doc for an ENT referral.

I called Al back and told him I was going to power through this. “No way I’m going to let a f-ing nosebleed stop me from doing this after thinking about it for years and finally getting here!” I said. Thank goodness, the combination of Vaseline and sea air seemed to do the trick. Eight days later as I write, even in drier air back home, I haven’t had another episode.

And here’s the thing: I’ve had Sjogren’s for decades. I’ve seen ENTs before. I’ve dealt with many nosebleeds. No one ever told me about the Vaseline. If you have the same problem, I hope it helps.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Brain Fog

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I forgot to write my blog for Tuesday morning. Completely slipped my mind on Monday, my usual blog-writing time, because I didn’t write it down in my Monday To-Do list. Usually, I organize myself in my bullet journal with a task list for the week, which I then break down for each day. But I’ve been busy with a lot of deadlines hitting at once, and I didn’t do the weekly task list, so I didn’t remember to write my blog.

Which is why, if you’re used to seeing this pop up in your in-box on Tuesday, it wasn’t there. Easy enough to “write it off” to aging, of course. But I had an interesting conversation with my Boston Medical rheumatologist on Tuesday that made me wonder. I was telling him how I feel that my memory just isn’t the same (this was before I realized I hadn’t written my blog, which gave me today’s theme . . . ).

Word-finding when I’m stressed has been hard ever since I hit menopause years ago, so I’m used to that. And we all know what it’s like to go into a room to get something and forget what it was. But now I’m finding that I can think of something I want to do and go to write it down (to remember), but the actual act of writing it makes the idea vanish for seconds or even minutes, sometimes. This is not only frustrating, but for someone who writes for a living and for my art, it’s upsetting. Fortunately, when I am thinking at the keyboard, the words continue to flow easily onto the screen.

Long-term memories are also getting harder to retrieve. Some of this is age, of course. But my maternal grandmother used to tell me stories from her twenties that were vivid with details. I had the same capacity for years, but now it just seems harder to recall long-ago details.

My rheumatologist tells me that brain fog is common with autoimmune disease. In the forty years I’ve had scleroderma, I never knew this. (Or if I did, I forgot!) Some of this has to do, in my case, with how my circulatory system is just not as efficient as it used to be due to the disease, so my brain isn’t as well-profused by blood. I also have Sjögren’s Syndrome as a secondary diagnosis, which causes dryness in my eyes, nose, and mouth, and apparently can also cause brain fog.

I haven’t changed medications in quite a while, other than eliminating a few that weren’t really helping me and cost way too much under Medicare. So this isn’t a reaction to drugs.

What to do? It comes back to the basics: get enough sleep, eat a balanced diet with foods high in omega-3 fatty acids and antioxidents, and exercise. I’m pretty good at the first two, and really need to improve at the latter. Over this past week, I barely got outside because of the cold. So on Tuesday afternoon, after my telemed call with my rheumatologist, I took a brisk walk.

A few hours later, when I finally wrote up my week’s To-Do’s, I remembered that I hadn’t written my blog. So, here I am, a day late. But at least I got here.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image: Phillip Belena

See at Last

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There is nothing like a new pair of glasses with an accurate correction. For months, now, I have been tolerating slightly blurred vision, the aftermath of 60 dives in a Hyperbaric Oxygen chamber last fall to heal my hands from major surgery. This is a common side effect of the treatment, and, as predicted, after about three months, my sight returned to almost normal.

But the almost part was pretty frustrating—just blurred enough so I had trouble reading street signs, especially later in the day when my eyes are drier from Sjogren’s. In any kind of auditorium setting, I had trouble clearly discerning people’s faces or what was projected on the movie screen. I kept waiting for my vision to settle down, but it never went back to what it was prior to the HBO therapy.

So, it was high time a couple of weeks ago to get a check-up and new prescription. Unfortunately, our vision insurance only gives a discount on new frames every two years, and I had just gotten new glasses last summer. Fortunately, however, a local college here trains optometrists, and as long as you are willing to take the extra time for an exam by the students, you get a 50 percent discount on frames at the college’s frame shop—also a training venue. It’s a great deal, and well worth being a guinea pig for the students, who are lovely, very earnest and dedicated to getting it right.

I picked up my new frames last Thursday. They are wonderful. Not only can I once again see all the leaves on trees and easily read signs when I drive, but I am now enjoying transitional lenses, which turn amber-brown in the sunlight. My eyes are incredibly light sensitive due to Sjogren’s dryness, and I have constantly fumbled with switching from clear lenses to prescription sunglasses when going in and out of buildings on a sunny day. Now the lenses do the work for me.

I’m still getting new prescription sunglasses. The one hitch with transitional lenses is that they don’t get completely dark in warm weather. The optician explained that the lenses are temperature sensitive, as well, and turn their darkest in winter months. Given the heat we’re sweltering in lately, I need more visual protection for summer.

But I’m happy. I can finally see what I want to see again, without eyestrain or fatigue. What a blessing.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image Credit: David Travis

Spotlight

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This past Sunday, I sang a solo. Our congregation was celebrating our beautifully renovated synagogue. I’m the alto in a quintet that sings on the High Holidays and for special occasions. One of our numbers was a barbershop mix set to the tune of Billy Joel’s “For the Longest Time.” I had the lead.

What a great piece to sing! And it’s rare for an alto to have the main melody. We’ve been practicing for weeks.

But, of course, despite all that preparation and encouragement from my fellow singers, I was nervous. Not just the typical oh-my-gosh-I’m-performing-in-front-of-hundreds-of-people nervous. It was scleroderma-related.

Years of lung scarring have made it harder for me to inhale a full breath, and it definitely affects my ability to hold notes and breathe with appropriate phrasing when I sing. I also have dry mouth from Sjögrens, and when I sing, I never know if I’ll either (a) have to cough at an inopportune moment or (b) collect so much saliva in my mouth that I can’t pronounce clearly. On Sunday, I was constantly clearing my throat before it was our turn—just this side of feeling like my throat would guck up.

Then there was the senior-moment-side of nervous. As many times as I’d reviewed my words, I was afraid my mind would freeze and I’d forget. Since the words were in Hebrew, they were harder to remember, even as the phrases were familiar (the opening prayer of the blessings after meals). Lately, I find that when I’m more self-conscious, my brain can go on the fritz for word recall, as if a file drawer gets stuck and refuses to open until I relax.

As a fallback, I had my music in front of me. But I wanted to make eye-contact with the audience.

Finally, it was our turn to sing. Two of the other members of the group are experienced barbershop singers, which was a good thing, since we were performing a capella. My nerves eased as we swung through the tune. In fact, our voices blended beautifully. I had enough breath, I didn’t cough, and I didn’t lose my place. A good sound system really helped. I felt great. We received many compliments afterward.

Most importantly, we had a wonderful time and added just the right bounce to an already upbeat morning. Music has a way of bringing joy into the world. I may not be able to play an instrument any more, but I’m so grateful I can still sing.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image Credit: Israel Palacio

Don’t Take No for an Answer

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Several months ago, I received a notice from the pharmacy that partners with our health insurance. They were no longer going to cover the Restasis eye drops I rely on for my Sjogren’s Syndrome dryness. Instead, I could substitute a prescription for Xiidra (ex-ID-ra). There was no explanation.

I called to be sure I understood. The customer service rep was snippy and dismissive. Still no explanation. I have extremely dry eyes, and it seemed as if there was no choice, so I contacted my optometrist and asked for a scrip for the new drops.

The first thing I noticed when I received the box of my new eye medicine was that the active ingredients are completely different. The second thing I noticed is that the Xiidra eye-drop capsules cannot be resealed, whereas Restasis capsules can be (even though you’re not supposed to, I’ve never had an issue getting two doses out of each capsule, which reduces waste and saves money).

The third thing I noticed was that the Xiidra drops burned like hell. Restasis can be irritating, too, but nothing like this. My eyes got red, my vision blurred, and there was no way I could put them in twice a day, as prescribed.

All of this was going on while my eyes were still readjusting after the hyperbaric oxygen therapy for healing my fingers. So it was hard to assess how much of my blurred vision was due to the drops, how much to dryness because I couldn’t tolerate the proper dosage, and how much to HBO aftermath.

For the past few months, I’ve been toughing it out, hoping I could adjust. And the longer I used the drops, old problems of light sensitivity and blurred vision as the day wore on resurfaced. Finally, I’d had enough. Al called our insurance and the pharmacy to find out how to appeal the decree. It was simple. I just had to ask my optometrist to contact the pharmacy and tell them I needed the Restasis because I couldn’t tolerate the Xiidra. Magic words: “medical necessity.”

Within a week, I had my Restasis again. And within only a couple of days, I could already tolerate sunlight better and see more clearly. Thank goodness. Lesson learned. Just because the Health Insurance Powers-That-Be limit your options, push back to get what you need.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Image Credit: Elena Taranenko